Tramadol
for Patients
Submitted:
April 3, 2007
Tramadol
may induce psychic as well as physical dependence of opioid. Dependence
and abuse, which includes drug-seeking behavior to unlawful actions to
take the drug, aren’t limited to patients with prior history of opioid
dependence. The risk in patients with substance abuse has been observed
to be widespread. Tramadol is associated with tolerance development.
It’s believed that if Tramadol is abruptly discontinued, withdrawal
symptoms may occur. Tramadol is absorbed orally, as it can be
administered in 50 to 100 mg tablets needed for pain relief every 4 to 6
hours (although not to exceed 400 mg/ day). Seizures normally occur in
patients taking the recommended doses, but are even more likely at high
doses combined with abuse of the Tramadol.
Dependence, along with tolerance and addiction to Tramadol, has
been validated. The abrupt cessation from Tramadol has been likened with
two types of withdrawal syndromes. One is customary of opioid drugs with
flu-like symptoms, drug and restlessness. This type is encountered in
about 90% cases of Tramadol withdrawal. The other withdrawal syndrome is
encountered in about 10% cases of withdrawal from Tramadol. This is
uncommon of opioids and more associated with extreme anxiety, confusion,
panic attacks, paranoia, hallucinations, as well as tingling and
numbness in the extremities.
Tramadol is normally well-tolerated as side-effects are generally
transient. The side-effects reported include constipation, dizziness,
drowsiness, nausea, vomiting and headache. Several cases declare that
Tramadol is abused for its opiate adverse effects. Recently, there were
an estimated 2,984 emergency room visits for Tramadol. Statistics show
that approximately 1.3 million people have used Tramadol non-medically.
It’s important to know that Tramadol is currently not controlled under
the CSA (Controlled Substances Act).
Tramadol undergoes a
particular hepatic metabolism through the cytochrome isozyme. Reduced
doses may be used in hepatic and renal impairment. The most common
adverse drug reactions are sweating, vomiting and nausea. Drowsiness is
reported, but is less of an issue in comparison to other opioids. A
common side-effect of most opioids, respiratory depression, is not
clinically important in normal doses. By itself, Tramadol can diminish
seizure threshold. When combined with inhibitors, tricyclic
antidepressants—or in patients with epilepsy—the seizure threshold is
further reduced. Seizures have been reported in humans receiving
excessive single oral doses (normally 700 mg) or large intravenous doses
(300 mg). Dosages of warfarin (coumadin) may need to be decreased for
anti-coagulated patients to refrain from bleeding complications.
Tramadol can increase the risk
of seizure in epileptic patients, namely with simultaneous use of
tricyclic antidepressants (Elavil). No dosage reduction or adjustment is
necessary in fit senor citizens 65-75 years of age. Patients over
75-years-old and those with kidney and liver dysfunction may need lower
amounts of dosage. Tramadol may rarely be habit-forming; it should be
avoided in patients with a history of opiate addiction or even
hypersensitivity to opiate medicines. Moreover, mitosis from Tramadol
may mask the extent, existence or intracranial pathology. Physicians and
clinicians should maintain a high index of suspicion for unfavorable
drug reaction when evaluating reworked mental status in patients
receiving Tramadol.
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